Video-Assisted Thoracoscopic Surgery (VATS) is a type of minimally invasive surgery used to diagnose and treat conditions that are found in the chest area of the body. A camera called a thoracoscope is inserted into the chest through small incisions, and the surgeon can guide the camera to perform a variety of procedures on the inside of the chest such as removing a piece of the lung, drain fluid, or perform a procedure on the heart or lung. VATS is commonly performed if the patient needs to have a portion of tissue removed if there are cancerous cells. VATS is also used to biopsy part of the lung, lymph nodes, the tissue around the lungs, heart, or esophagus.
Types
- A VATS Lobectomy is a procedure where a large section of the lung is removed, often to treat lung cancer. During a VATS lobectomy, a surgeon will make small incisions on the chest and guide the camera through to aid in visualizing which sections of the lung need to be removed. A traditional lobectomy requires a larger incision whereas the VATS procedure is much less invasive.
- VATS thymectomy is a procedure that removes the thymus, a common source for the disease myasthenia gravis, a disease that can produce the growth of tumors (cancerous and non-cancerous) on the thymoma gland, which lays on the front of the chest. VATS uses small incisions on the chest along with the thoracoscope and other tools to help the surgeon see and remove the thymus and any other necessary tissue.
- VATS Sympathectomy for Hyperhidrosis. Hyperhidrosis is a condition that causes excessive sweating brought on by exercise, stress, and/or embarrassment, but most commonly, rarely triggered by anything. Our surgeons are trained in VATS Sympathectomy, also known as endoscopic thoracic sympathectomy. During this procedure, a small incision is made, and using a thoracoscope and other tools, the sympathetic nerve is divided, allowing for long term results of decreased sweating.
Treatments
VATS is commonly performed:
- If the patient needs to have a portion of tissue removed, if cancerous cells are present.
- If the patient needs to biopsy part of the lung, lymph nodes, the tissue around the lungs, heart, or esophagus.
- For procedures on the heart such as atrial fibrillation ablation, pacemaker lead placement, and repair to the mitral valve.
Before the Procedure
- Stop smoking as soon as possible. You must be completely cigarette-free for at least two weeks prior to surgery. Nicotine replacement and medication options are available to help you quit.
- Exercise as much as possible. Even a short daily walk around the block can drastically improve recovery. Patients are asked to walk the halls of the hospital on the morning before surgery. Better stamina prior to surgery leads to better stamina following surgery.
- You can continue taking aspirin; however, patients must refrain from any other blood thinners following instructions from your clinical care team.
- You may continue to take other medications as usual, unless specifically discussed during your preoperative visit with an anesthesiologist.
- Do not eat or drink after midnight before the day of surgery.
- On arrival to the surgical unit, you will have an IV placed and be prepared for surgery. You will meet with the anesthesia and surgical teams prior to your operation.
During the Procedure
This surgery is performed via three to five small incisions on the side of the chest. Patients can expect one cut approximately two inches long to allow for the removal of the lobe from the chest and the rest less than 1 inch long. These incisions allow us to work between the ribs without spreading the ribs apart with a retractor. The operation typically takes approximately two hours.
After the Procedure
- Deep breathing and coughing are the most important things that you can do to speed up your recovery. There is a tendency to avoid these things due to chest discomfort following surgery. Our goal is to minimize your discomfort while encouraging you to cough up any secretions (phlegm). These efforts are important to prevent pneumonia.
- Patients receive a small device called an incentive spirometer to help encourage deep breathing several times per hour. A respiratory therapist will show you how to use it.
- In addition to the nerve blocks performed during surgery, you will be provided a multimodal approach to pain control. This means that we will use different types of medications to manage the pain. These will include a combination of non-narcotic and narcotic medications by mouth. Intravenous narcotics are available as needed, but our goal is to minimize their use. As you recover in the hospital and at home, your goal should be to minimize oral as well. While you may take an oral narcotic pill every 4-6 hours immediately following surgery, once your chest tube is removed and you are discharged from the hospital, we recommend you begin to gradually space out the doses to wean yourself off.
- As long as you are taking narcotics, you will receive a stool softener daily. Narcotic consumption can contribute to constipation. In addition to stool softeners, other medications are available if you suffer from constipation following surgery.
- Although most patients experience a reduced appetite after surgery, you are free to eat and drink. One side effect is nausea. You will be provided medication to reduce any stomach discomfort. Vomiting can be dangerous after surgery, so we ask that you avoid foods that may upset your stomach. If you are not hungry, we encourage you to drink fluids slowly until your appetite returns.
The day after surgery
- We aim to have the urinary catheter removed the day after surgery.
- We will routinely stop any continuous IV fluids. We want you to be able to be out of bed as much as possible without the constraints or risks of IV tubes.
- Our goal is to have you sitting in a chair for breakfast.
- You should walk the halls with assistance from the nursing staff and/or physical therapy on the day following surgery. Short, frequent walks are key to your recovery. Walking after surgery prevents problems such as pneumonia, constipation, and blood clots in your legs.
- We will remove the chest tube when the drainage output is low enough and there is no air leaking from the A specialist will test you for air leakage frequently by having you cough and will monitor the tube for bubbles. Usually, the tube is removed one to three days following surgery. Removing the chest tube is an indication of strong recovery and good progress. Most patients leave the hospital a few hours after tube removal or the next morning.
- After surgery, you will receive supplemental oxygen. The goal is to wean the oxygen off in the days following surgery. Your oxygen saturation level is monitored to allow us to wean and remove the supplemental oxygen as long as your saturations are appropriate (above 92%).
At home
- The chest tube site will be covered with a gauze dressing at the time of tube removal. This site may drain fluid for 24-48 hours. Patients will receive gauze to change the dressing if it becomes wet. Otherwise, you can remove the dressing and shower 24 hours after tube removal.
- The other surgical sites are closed with absorbable sutures and do not require special care. You can wash the surgical sites with soap and water, and pat them dry with a towel.
- You should continue to wean off any narcotic medication as soon as possible.
- Avoid lifting anything over 10 lbs. until your follow-up appointment.
- Take your IS (spirometer) home with you. You should continue to use it as frequently as you can, at least several times daily. This will help you to continue to expand your lungs and cough up any secretions.
- You should continue to take short, frequent walks at home. There are no restrictions on your amount of exercise, other than no heavy lifting. You are encouraged to increase your exercise daily, as tolerated. You should expect some fatigue and shortness of breath with your exercise. That’s OK. Don’t become discouraged. Rest when necessary. Most people find that they can build their exercise stamina back to pre-surgery levels within four to six weeks.
- Do not drive if you are taking narcotics. Once you are completely weaned from any narcotic medication, you can drive if you feel safe doing so.
Advantages
The goal of a video-assisted minimally invasive lobectomy procedure is to remove the lobe of the lung containing cancer as well as the surrounding lymph nodes while minimizing surgical trauma. Evidence has shown that reduced surgical trauma leads to less pain, fewer complications, and faster recovery compared to a lobectomy through a conventional open incision (thoracotomy). These operations are performed under general anesthesia. A special breathing tube is placed for surgery and is almost always removed before you awake from anesthesia.
Typical Recovery Time
Follow-up office visit
- Call the office to schedule a follow-up visit two to three weeks after discharge.
- You will have a chest X-ray done on the day of the office visit.
- Call the office sooner if you are concerned that you are not recovering appropriately. Some obvious reasons to call would be fever over 100.4°F, worsening chest pain or shortness of breath, or redness at the incision sites.
Long-term follow up
- All patients with lung cancer need follow-up visits and X-rays periodically to ensure that there is no evidence of cancer recurrence or a new lung cancer.
- Most patients with Stage 1 lung cancer do not have a medical oncologist, as they do not require chemotherapy. In these patients, your physician will arrange for surveillance visits every six months.
- You will have a follow-up chest X-ray at your 6-month visit.
- You will have a CT scan at your 1-year visit.
- We will alternate chest X-ray and CT scans every six months for a period of five years.
- Patients with more advanced cancers (Stage 2 and above) will have visited with an oncologist, as chemotherapy is recommended. In these situations, the surveillance visits and imaging tend to be more frequent and intensive, often with CT or PET scans every four to six months. These will be at the discretion of the medical oncologist.
Results and Post-Procedure Care
The final pathology report concerning the exact size of the cancer and status of the lymph nodes (pathologic stage of cancer) is typically available within a week of surgery. Patients are typically discharged prior to the report’s availability; therefore, the results are disclosed at a follow-up appointment.
If you have specific concerns about a procedure or your health, please consult a physician.